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Leader (1850-1860), 25th September 1858, Edition 1 of 2, Page 1004, Untitled Article

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      Untitled Article

      - ' As shown in details in Tables I ., II ., III ., IV . ^ V ., and ' VI ; inclusive , the mortality per cent , has been determined for the different terms of life , and for the various classes of diseases . 1 st . JFor the-whole of England and Wales . 2 nd . For London . Srd . For those districts of the kingdom in which the density of population varies 'from 28— . 72 per hector ( the hector equals nearly ' . 2 j acres ) . 4 th . For districts in which the density varies from 84— . 99 . ' . 5 th . For Lancashire ( . 28 or 7-10 acres ); and 6 th . For the residue of the population of England and Wales .

      If it be true that increasing dens ity of population , particularly in the sense in which it is understood in regard to barracks ' sleeping accommodation , has a tendency to augment diseases of the lungs more than all other diseases , then it is evident that districts in which the sleeping accommodation differs so widely must show a marked difference in the ratio of deaths taking place from phthisical causes . No doubt the results of . the influence of a uniformly and generally increased density of population in a district which i « not , in arty considerable portion of it , highly intensified in its overcrowding , would be uniformly com-, pared with the results of a district or section of population which is throughout overcrowded ; but in London , or Lancashire , and in the third district of England now under consideration , we have been long accustomed to hear reports through the *' Hestlth of Towns Commission" of great and , in many instances , of major portions of them being overcrowded to a degree which shocks morality and the ordinary notions of common decency . : Into ; these details it is now unnecessary to enter ; they , are patent to all giving attention to questions affecting the public health . Although , therefore , there ^ js no one district of the kingdom in which - ^ there i $ a uniform system of overcrowding , still there ] are many- ^ -and among them those now under review- ^ in which the overcrowding of the large portions of them is such that if the hypothesis be of any value , there must be at the least a slightly augmented ratio of death from consumption compared with the general ratio of increase from all causes . Let us see how far this is in agreement with recorded facts . It must be clearly understood that the hypothesis on which the commissioners rest their conclusions in not simply that overcrowding may induce phthisis in an increased ratio—that would probably be deniedtneaeatns irom diseases oi

      In . tne army , me lungs are absolutely , as well as relatively , to the deaths from all other . causes , in a ratio so high , beyond all precedent and example , as to form a new and important problem for solution in vital statistics .. The hypothesis , therefore , of the Commissioners resolves itself into the following : —That " oyercrowdihg , " althqugh it increases the general mortality , has the peculiar characteristic of intensifying the deaths from diseases of the lungs greatly beyond those from all other causes . " On referring to Abstract B . preceding , it will be found that the total excess of deaths above the average for England and Wales ia 1931 . 57 , while at the same ages , in diseases of the " respiratory organs " only , it will be seen there is an excess of no less than 1 . 397 . 45 deaths , or at about 70 percent , of the whole „ jncrease . ¦^ "SjfSSffTBsult deserves the most careful and patient consideration . Again , on referring to the abstract B . preceding , ; it will be seen that , according to the mortality of England and Wales , the normal ratio of deaths from diseases of the " respiratory organs" is 44 . 4 B per cent . ; and yet of the whole excess of deaths irora all causes no less than 70 per cent , is due to the organs of respiration . The"ffttViiwpprta ^ iis ' e " of this result will be perhaps better appreciated by the following illustration : — Actual number of deaths from diseases of the respiratory organs == 2 . 675 . 0 Normal number of deaths = 1 . 277 . 6

      Difference of excess ; = 1 . 397 . 4 = ' 1 O 9 percent . If the : residue of the deaths from all other causes whatever be viewed in this manner , the resvlta are—Actual number of deatha from all other causes ... = » 1 . 807 . 0 Normal number of . deaths < = » 1 . 211 . 8 ¦¦¦» Pifference'Oive 3 cceBa " " -m "» " 595 iaTp .. 49-per'centr These results conclusively ehow that the condition of the array is such as to induce an excess of diseases of the organs of respiration , with a much higher intensity tnan all other diseases collectively i in fact , theexcensof deaths frpra : diseases of the organs of respiration , is considerably more than double that from aUi other causes , ' , WMb peoqliar feature in the mortally of the army h ^ ft opt ^ n pbpe , rved in any other series of observritiono ^ ^ nd , k ; ii of the utmost importance , to

      determine whether the solution of it offered by the Commissioners be the correct one . v ¦ Should their hypothesis be found not in accordance with facts and experience , then the most serious consequences must result from it to the sanitary state of the army ; as , without the true solution , there is little chance of effectual remedies being applied- . / •• ' In Tables I . to VI . inclusive , appended , are given the ratio of mortality per cent , from all specified causes at the different terms of life ; but I shall now refer simply to the results for the soldiers' ages as given in the following abstract of the tables . Abstract C . Ratio of Deaths from each Cause to the total Deaths from all Causes in the following Districts . ( Soldiers Ages . )

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      Tnn 4 . THE LEADER . [ Ho . 444 , September 25 , 1858 .

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      . ' ¦¦ ' t Jg ^ g * $£ ~ 6 Group of Diseases . | = 3 J I g I | f ' : ¦ ¦•• S ^ " < = !*> P « ^ iR i $ 2 S 8 & tr& ^ yT ™*^ ' **^ cular Diseases aiid f . Diseases of the Re-f spiratory Organs .. J + 19 . 3 + 32 . 3 + 17 . 7 —13 . 5 —3 & 5 x _ . + 15 . 2 + 22 . 2 ' + 7 . 5—12 . 6—19 0 3 . Zymotic ¦ Diseases ; .... + 41 .. + S 8 . o + le 7 -17 . 2—56 . 3 4 . Diseases of the NcrO vous System and > Digestive Organs .. J + 19 . 8 + 22 . 2 + 16 . 7 — 4 . 8 —38 . 9 5 . Sudden and External | | Causes ••• —10 . 0 + 20 . 9 + lO . o !— S . 6 + 9 . 1 6 Other Diseases + 32 . 1 + 3 : 7 , — 1 . 8 . '— 0 . 9 ' —31 . 2 7 . All Causes + 19 . 91 + 23 . 1 + 9 . 6 — 10 . 2—27 . 8

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      In viewing the preceding abstract it is right to explain that the results in the first line are of the most importance , as in the army P / tthisis Puhnonnlis constitutes about 80 per cent , of the deaths from diseases of the I lungs , and about 50 per cent , -of the deaths from all causes . This being explained , the results in abstract D are , as bearing on the applicability of the hypothesis in question on the causes of the mortality in the army , even more remarkable than those in abstract G . In every instance , except one , the differences between the mortality per cent . in the respective districts from phthisis , and that for England and Wales , are less than the differences between the mortality from all causes , showing that death from phthisis . is more positive in its determination—in other words , less subject to fluctuation , arid less affected by external causes than the other diseases in . tlie aggregate . trie increase

      In London , the densest of the districts , beyond that of the country generally from death by phthisis is 14 per cent ., while the increase from all causes is about 20 per cent . ; but in the least dense portion of the kingdom , as shown in the last colum of Abstract D , the decrease from Phthisis is precisely 14 . 8 per cent ., but that from all causes 27 . 8 per cent ., reversing exactly the positions held -by these diseases in the army , as already pointed out , in which it was shown that the deaths from diseases of the lungs were in excess of the normal number 109 per cent ; but the deaths from other causes were in excess only 49 per cent . There appears , therefore , no relation between the hypothesis advanced by the Royal Commission and the causes of the actual increase of mortality which has taken place . If the great havoc made in the ranks of the British army while at home had been occasioned through deaths from zymotic causes , then tlie hypothesis under'discuasion would , if applied to that class of diseases , have held good , and the conclusion they have arrived at might have been suggestive of ulterior proceedings , beneficial to the brave men have to fight our battles , improving to their moral conditions and physical power , thereby enhancing the financial resources of the empire . The results in the third line of Abstract 1 ) . arc exactly confirmatory of those in Abstract C , showing that density of population is only powerful in developing zymotic diseases . It is somewhat rem « rKable that the results of the two abstracts , in wlncn the mode of expressing the relation of the facts recorded is so decidedly different , should agree preciseK , showing , in both instances , that the 0111 / diseases which follow the order of density in tneir development is the zymotic class . _ ... , dentiia

      If in Abstract 1 > the results for the jrv »» the whole class of diseases of the *'^" P'JfjW organs" be taken into consideration instead ot tnoso from phthisis pulmonalis , only the same reasoiung _ nnu argument will bo found to apply , the deaths from consumption being always more constant , »« = affected by external circumstances , and showing ' ' »«» disturbance in their development in tho uillorons districts than the remaining discuses . ' » lffl 0 , ' ,, '„ " pare in any considerable portion of the P ° I ) U |" V ° "' which is either more or loss crowded than thoajorago of the kingdom , tho deaths from phthisis an < tl "i 8 « 118 ^ of tho respiratory organs , and the ratio will »« « ° »»" Always subject to loaa-perturbation than tho resiuuo T of ^ aU * other » diaeH 6 e 8 . ¦ » . » ' w . >— « » <¦¦ ' > ¦¦ '{<; ' ¦ Wr * If tho hypothesis of the commissioners 1 wore tneru fore well founded this would not be * of for «»« " •* in which there wao a largo amount of over-crowa ""* would , when compared with those thinly P « P " J { J " J [ show , to a leas or greater extent , tho vroll- "JJJJ peculiarity of the mortality in tho army o '^ 'iS " Ing deaths from oWumptidn more tiwn those twm othor cnuaoB . Tho present invcBtlgation , In jwojj ; ' . shows that overorowcUng produces the very o |> po " oflect , and that deaths from consumption « ro

      Untitled Article

      tricts enumerated in Abstract C .... ... . ; . 52 . 1 „ It will be seen that the effect of density and overcrowding is not to intensify pulmonary disease sp -much as the class of zymotic diseases . Tlie third line of this abstract gives a striking-illustration of tliis ; reading from the last column toward the first , it will appear that the relative amount of zymotic diseases to those from all causes increases gradually , and almost uniformly , with the ratio of density , from 11 . 6 per cent , in the least dense districts to 22 . 6 per cent , in London , the most closely-packed district ; the results for England and Wales , which include all the districts , being of course intermediate . The diseases of the nervous system and digestive organs exhibit a somewhat remarkable uniformity throughout all the groups .

      A careful examination of the results given in this abstract , leads to a conclusion quite at variance with the hypothesis of the Commissioners . In fact , in the densest districts , the mortality from diseases of the lungs is relatively to the deaths from all causes much less than in the more thinly peopled districts . In London the deaths are 44 . 8 per cent . England and Wales , 46 . 5 „ And in the residue of the country , after deducting the

      dis-It is when the results of the mortality in the army are given in the particular form of expression adopted in the preceding abstract , that they appear anomalous , the mortality from diseases of the lunga being among the Household Cavalry ... 59 . 0 of the whole deatha . Dragoon Guards , &c ... 53 . 9 do . Infantry of the Line ... 57 . 3 do . Foot Guards ... ... 67 . 7 do . These results are very singular , and will appear still more so if it be kept in view—throwing out of comparison the Household Cavalry , a very small

      abstract will therefore show , for each cause of death in the army , whether it is in greater or less activity than in the country generally . Abstract D . ' Differences between the Mortality percent , in the following Districts , and thnt for England and "Wales ( Soldier ' s Ages . )

      body , awd therefore subject to marked fluctuationsthat as the general mortality increases , so does tho ratio of deaths from diseases of the lungs increase . If , therefore , over-crowding were the main cause of developing so inordinate ^ ah amount ' of corisumptionj the barrack accommodation for the different branches of the service should be found contracting in the order in which the general mortality , as well as that from consumption , increases ; but it happens to be quite otherwise . A careful examination of the preceding facts , it is believed , doea anything but snpport the hypothesis now under consideration of the Commissioners .

      There is however , another and In some respects a more simple , and in unskilful hands a safer , way of solving this question , and that is , instead of taking the ratio of the mortality from " one cause" to tho mortality from " all causes , " to determine the actual T ^ e ^ fTnW 5 flrf y ~ ff ^ m ~" accordingly placed all the preceding results in that form . The detailed tables hereto appended give the results for various terms of life ; but in the abstract to which I ask the attention of the section , reference will be made to the results for tho soldiers' ages only . In the preparation of the following abstraot , the actual mortality per cent , at the given ages was in the first place determined , and then the differences por cent , between these results and the correspond " ing ones for England and Wales were found , and the

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      "" * «* Z Z ~ Group of Diseases . gjj ¦ •§ g | f ! ll « j 5 ^ 3 g fi fl S up . W i-3 1 . Phthisis 37 . 0 35 . 2 36 . 6 35 , 4 362 43 . 7 2 . Residue of Tubercular ") . | - S&SiSSSSZ&i J ± _ i : i ^ i 22 ? _ L « -L 4 - gans ... ..... ¦• - ' 46 . S 44 . 8 49 . 3 45 . 6 45 . 4 ! 52 . 1 3 . Zymotic Diseases .- 19 . 1 22 . 6 21 . 4 20 . 3 17 . 6 11 . 6 4 . Diseases of the Nervous ") i I System and Digestive V 126 12 . 5 12 . 5 13 . 5 13 . 3 10 . 7 Organs ) I . 5 . Sudden and External ) 110 8 . 2 10 . 7 ! 10 . 9 li 7 15 . 3 Causes ............... 3 > G . Other Diseases . . 1 Q . 8 11 . 9 , 9 . 1 9 . 7 12 . 0 10 . 3 7 . All Causes 00 . 0 100 . 0 100 . 0 100 0 100 . 0 100 . 0

  • Citation
    • Leader (1850-1860), Sept. 25, 1858, page 1004, in the Nineteenth-Century Serials Edition (2008; 2018) ncse2.kdl.kcl.ac.uk/periodicals/l/issues/vm2-ncseproduct2261/page/20/